An Acceptance-Based Behavioral Intervention for Weight Loss: A Pilot Study

doi:10.1016/j.beth.2011.10.005

Behavior Therapy

Volume 43, Issue 2, June 2012, Pages 427-435

https://doi.org/10.1016/j.beth.2011.10.005 Get rights and content

Abstract

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age = 52.2 ± 7.6 years; baseline mean body mass index = 32.8 ± 3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE = 1.4) after 6 months of treatment and 12.1 kg (SE = 1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r = .64, p = .002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.

Highlights

► We tested the efficacy of an acceptance-based behavioral weight loss intervention. ► Participants were overweight and reported internal disinhibition. ► Average weight loss at 6-months was 12 kg and it was maintained at 3-month follow up. ► Acceptance-based approaches to weight loss warrant further study.

Section snippets

Participants

Participants were recruited via newspaper advertisements that sought individuals interested in weight loss who also have trouble controlling their eating when stressed. Potential participants were screened by phone and then in person to determine eligibility. Eligibility criteria included age between 21 and 70 years, body mass index (BMI) between 27 and 40 kg/m², and a score of 5 or greater on the internal disinhibition subscale of the Eating Inventory (scores on this subscale range from 0 to 8).

Results

The 21 participants (19 females; 2 males) who entered the trial were age 52.2 ± 7.6 years, with a BMI of 32.8 ± 3.4 and body weight of 88.8 ± 11.2 kg. Ninety percent reported that they were non-Hispanic White, 4.8% Hispanic, and 4.8% other. Eighteen of 21 participants (86%) completed the 6-month assessment and 3-month follow-up. There were no baseline differences between completers and noncompleters on demographic characteristics (gender, education, racial/ethnic background) or outcome variables (BMI,

Discussion

This study piloted the use of an acceptance-based behavioral weight-loss intervention, evaluating its acceptability, feasibility, and initial effectiveness in individuals reporting high levels of internal disinhibition, or tendency to eat in response to emotional or cognitive cues. High levels of internal disinhibition have been associated with difficulty with both initial weight loss and weight-loss maintenance and may contribute to the high level of variability in outcome of standard

References (35)

E.M. Forman et al.
An open trial of an acceptance-based behavioral intervention for weight loss
Cognitive and Behavior Practice
(2009)
E.M. Forman et al.
A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study
Behaviour Research and Therapy
(2007)
L.M. McCracken et al.
Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase
Behaviour Research and Therapy
(2005)
A.J. Stunkard et al.
The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger
Journal of Psychosomatic Research
(1985)
K. Tapper et al.
Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women
Appetite
(2009)
D.W. Woods et al.
A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania
Behaviour Research and Therapy
(2006)
R.A. Brown et al.
Cognitive-behavioral treatment for depression in alcoholism
Journal of Consulting and Clinical Psychology
(1997)
R.A. Brown et al.
Distress tolerance and duration of past smoking cessation attempts
Journal of Abnormal Psychology
(2002)
R.A. Brown et al.
Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings
Behavior Modification
(2008)
M.L. Butryn et al.
Reductions in internal disinhibition during weight loss predict better weight loss maintenance
Obesity
(2009)

Diabetes Prevention Program Research Group

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

New England Journal of Medicine

(2002)

E.A. Finkelstein et al.

State-level estimates of annual medical expenditures attributable to obesity

Obesity Research

(2004)

K.M. Flegal et al.

Excess deaths associated with underweight, overweight, and obesity

Journal of the American Medical Association

(2005)

E.M. Forman et al.

Preliminary outcomes from the Mind Your Health project: A randomized controlled trial comparing standard behavioral and acceptance-based behavioral interventions for obesity

E.M. Forman et al.

A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression

Behavior Modification

(2007)

J.A. Gregg et al.

Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial

Journal of Consulting and Clinical Psychology

(2007)

J. Karlsson et al.

Psychometric properties and factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. Results from the Swedish Obese Subjects (SOS) study

International Journal of Obesity and Related Metabolic Disorders

(2000)

Cited by (81)

Efficacy of ACT-based treatments for dysregulated eating behaviours: A systematic review and meta-analysis
2022, Appetite
Citation Excerpt :
The AAQ and AAQ-II are currently the most widely used measures of psychological inflexibility (or experiential avoidance) (Bond et al., 2011). Nine studies (Afari et al., 2019; Levin et al., 2021; Levin et al., 2018; Lillis et al., 2009; Lillis et al., 2016; Niemeier et al., 2012; Potts et al., 2020; Sairanen et al., 2017; Weineland, Arvidsson, et al., 2012) administered the 22-item Acceptance and Action Questionnaire for Weight-Related Difficulties (AAQ-W) (Lillis & Hayes, 2008), which measures psychological inflexibility specifically related to difficult weight-related thoughts, feelings and actions. Seven studies (Berbette, 2016; Bradley et al., 2016; Carels et al., 2019; Forman et al., 2009; Frayn et al., 2019; Juarascio et al., 2017; Katterman et al., 2014) used the 10-item Food Craving Acceptance and Action Questionnaire (FAAQ) (Juarascio, Forman, Timko, Butryn, & Goodwin, 2011) to assess acceptance of internal experiences that pertain to food and eating such as urges, thoughts, and cravings.
An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change.
To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change.
Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted.
A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments.
Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.
Technological Interventions for Eating and Weight Disorders
2022, Comprehensive Clinical Psychology, Second Edition
Eating disorders and obesity have many characteristics in common. In both, weight-related problems play a central role. There is growing interest in identifying their common risk factors, and research shows that unhealthy weight-control behaviors are common antecedents to both obesity and eating disorders. There are currently interventions available that have shown some efficacy, with variability depending on the disorder under consideration. The incorporation of technological resources such as virtual reality, information and communication technologies, and games with physical activity, allows for even higher levels of efficacy, as shown by the randomized controlled studies that have been conducted to date. The available evidence, therefore, permits to recommend this type of applications. Future research must be focused not only on the treatments that are offered once these problems have emerged but also on preventing them.
Confirmatory factor analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States sample of adults with overweight and obesity
2020, Journal of Contextual Behavioral Science
To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB).
Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores.
The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity.
Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.
Psychological inflexibility and clinical impact: Adaptation of the Acceptance and Action Questionnaire-II in a sample of patients on haemodialysis treatment
2020, Nefrologia
Few studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients.
Prospective cross-sectional study with patients on haemodialysis (N = 186).
The fat tissue index (15.56 ± 5.72 vs. 18.99 ± 8.91, P = 0.033), phosphorus levels (3.92 ± 1.24 vs. 4.66 ± 1.38; P = 0.001) and interdialytic weight gain (1.56 ± 0.69 vs. 1.89 ± 0.93, P = 0.016) were higher in patients with a higher PI score. Phosphorus levels (P = 0.013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P = 0.026) of the variability of phosphorus levels.
The adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions.
Apenas existen estudios que hayan investigado el papel que la inflexibilidad psicológica (IP) pudiera tener en el contexto de la IRC. El objetivo primario de este estudio fue analizar las propiedades psicométricas, la fiabilidad y la validez de la versión española del Acceptance and Action Questionnaire – II (AAQ-II) adaptada al contexto de pacientes en tratamiento de hemodiálisis (HD). El objetivo secundario fue analizar la relación entre IP y parámetros relacionados con la adhesión al tratamiento y calidad de vida en este tipo de pacientes.
Estudio transversal prospectivo con pacientes en hemodiálisis (N = 186).
El índice de tejido graso (15,56 ± 5,72 vs. 18,99 ± 8,91; p = 0,033), los niveles de fósforo (3,92 ± 1,24 vs. 4,66 ± 1,38; p = 0,001) y la ganancia de peso interdiálisis (1,56 ± 0,69 vs. 1,89 ± 0,93; p = 0,016) fueron mayores en los pacientes con más puntuación en IP. Los niveles de fósforo (p = 0,013) explicaron de forma significativa la variabilidad de los niveles de IP, la cual también se mostró como un predictor significativo (p = 0,026) de la variabilidad de los niveles de fósforo.
La adaptación del cuestionario AAQ-II al contexto de HD da lugar a una medida válida y fiable de la IP para este tipo de pacientes y los resultados de este estudio parecen apoyar el papel de la IP con relación a parámetros de salud y calidad de vida en el ámbito de las patologías crónicas.
Mindful eating for weight loss in women with obesity: A randomised controlled trial
2023, British Journal of Nutrition
The moderating and mediating role of eating behaviour traits in acceptance and commitment therapy-based weight management interventions: Protocol for an individual participant data meta-analysis
2023, BMJ Open

View all citing articles on Scopus

^☆: The authors would like to thank Rheanna Ata; Jacki Hecht, RN; Erica Robichaud, MSW, RD; and Victoria Winn for their invaluable assistance on this project. This research was supported by Grant 5K23-DK73536 from the National Institutes of Health.

View full text

An Acceptance-Based Behavioral Intervention for Weight Loss: A Pilot Study☆

Abstract

Highlights

Section snippets

Participants

Results

Discussion

Cognitive and Behavior Practice

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Psychosomatic Research

Appetite

Behaviour Research and Therapy

Cognitive-behavioral treatment for depression in alcoholism

Journal of Consulting and Clinical Psychology

Distress tolerance and duration of past smoking cessation attempts

Journal of Abnormal Psychology

Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings

Behavior Modification

Reductions in internal disinhibition during weight loss predict better weight loss maintenance

Obesity

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

New England Journal of Medicine

State-level estimates of annual medical expenditures attributable to obesity

Obesity Research

Excess deaths associated with underweight, overweight, and obesity

Journal of the American Medical Association

Preliminary outcomes from the Mind Your Health project: A randomized controlled trial comparing standard behavioral and acceptance-based behavioral interventions for obesity

A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression

Behavior Modification

Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial

Journal of Consulting and Clinical Psychology

Psychometric properties and factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. Results from the Swedish Obese Subjects (SOS) study

International Journal of Obesity and Related Metabolic Disorders